Physician's Assistant

Patient Details

Sdec (257 days ago 11:22)

Sdec Wed 23 July 2025 11:22

Last Modified: 257 days ago

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Content:

Presenting Complaint:
Jaundice, abdominal pain, and fever

Past Medical History
• Previous rugby injury with abdominal trauma (3 months ago)
• No known allergies
• No regular medications

Diagnosis:
Infectious mononucleosis (EBV) with jaundice

I had the pleasure of meeting Mr Ellis in Same Day Emergency Care today.

Mr Ellis is a young man presenting with a several-day history of abdominal pain, jaundice, fever, and constitutional symptoms. He describes left-sided abdominal pain that has progressed to a tight band-like sensation around his chest and abdomen. He reports early satiety, having only consumed a pot noodle over the entire previous day. He has noticed yellowing of his sclera over the past 4 days, which appeared after the onset of abdominal pain.

Associated symptoms include fever with night sweats (drenching over the past month), palpitations, fatigue, memory difficulties, scratchy throat, and easy bruising. He has had significant weight loss over the past year. He reports palpitations both at rest and on exertion, along with dizziness on standing.

Social history reveals he lives alone in temporary accommodation, is unemployed, and has a complex social background with no local support. He has recently stopped smoking cannabis and has minimal recreational drug use history. He recently travelled to Wales (Abercynon area).

On examination, he appeared unwell with obvious scleral icterus. He was febrile (37.3°C) with tachycardia (heart rate ~90bpm). Abdominal examination revealed mild tenderness in the right upper quadrant with no organomegaly palpable. There was evidence of bruising on his lower limbs, non-tender to palpation.

Investigations:
Blood tests 21/07/2025: CRP 5 (normal), albumin 58 (raised), bilirubin 77 (elevated), ALT 26, FBC normal, blood cultures negative, venous blood gas showing mild alkalosis
Ultrasound abdomen: Unremarkable liver appearance, thin-walled gallbladder with minor biliary sludge, sonographic Murphy's sign negative, no intrahepatic ductal dilatation, unremarkable pancreas, kidneys and spleen

Plan:
1. Blood tests including acute hepatitis screen
2. If LFTs improving or static, discharge home with repeat LFTs on Friday
3. If LFTs worsening, consider admission under hepatology
4. Paracetamol for fever management

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Patient Details

Sdec Wed 23 July 2025 11:22

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